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Antiretroviral therapy as a risk factor for chronic kidney disease: Results from traditional regression modeling and causal approach in a large observational study

OBJECTIVE: We investigated whether patients receiving selected antiretroviral combinations had a higher risk of chronic kidney disease (CKD) using traditional regression modeling and a causal approach in a large prospective cohort. PATIENTS AND METHODS: For the purpose of this study, we selected 630...

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Autores principales: Cuzin, Lise, Pugliese, Pascal, Allavena, Clotilde, Rey, David, Chirouze, Catherine, Bani-Sadr, Firouzé, Cabié, André, Huleux, Thomas, Poizot-Martin, Isabelle, Cotte, Laurent, Isnard Bagnis, Corinne, Flandre, Philippe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5720720/
https://www.ncbi.nlm.nih.gov/pubmed/29216208
http://dx.doi.org/10.1371/journal.pone.0187517
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author Cuzin, Lise
Pugliese, Pascal
Allavena, Clotilde
Rey, David
Chirouze, Catherine
Bani-Sadr, Firouzé
Cabié, André
Huleux, Thomas
Poizot-Martin, Isabelle
Cotte, Laurent
Isnard Bagnis, Corinne
Flandre, Philippe
author_facet Cuzin, Lise
Pugliese, Pascal
Allavena, Clotilde
Rey, David
Chirouze, Catherine
Bani-Sadr, Firouzé
Cabié, André
Huleux, Thomas
Poizot-Martin, Isabelle
Cotte, Laurent
Isnard Bagnis, Corinne
Flandre, Philippe
author_sort Cuzin, Lise
collection PubMed
description OBJECTIVE: We investigated whether patients receiving selected antiretroviral combinations had a higher risk of chronic kidney disease (CKD) using traditional regression modeling and a causal approach in a large prospective cohort. PATIENTS AND METHODS: For the purpose of this study, we selected 6301 patients who (i) started their first antiretroviral regimen after 1(st) January 2004, (ii) had at least one serum creatinine measurement within 6 months before ART initiation (study entry), and (iii) had at least two measurements after study entry. Baseline eGFR was defined from the last serum creatinine measurement before study entry. All eGFR values were calculated using the Modification of Diet and Renal Disease (MDRD) equation. Both traditional Cox proportional hazards model and Cox marginal structural models were applied. Distinct coding for antiretroviral therapy exposure were investigated as well as double robust estimators. RESULTS: Overall we showed that patients receiving tenofovir (TDF) with a ritonavir boosted protease inhibitor (rbPI) exhibited a higher risk of CKD compared with patients who received TDF with a non-nucleosidic reverse transcriptase inhibitor (NNRTI). Such an increased risk was observed considering both initial and current regimens. Our analysis revealed a clinician-driven switch away from TDF among persons experiencing a decline in renal function while receiving this drug. CONCLUSION: Our results show that combination of TDF and boosted protease inhibitor is associated with a higher CKD risk than TDF and a NNRTI.
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spelling pubmed-57207202017-12-15 Antiretroviral therapy as a risk factor for chronic kidney disease: Results from traditional regression modeling and causal approach in a large observational study Cuzin, Lise Pugliese, Pascal Allavena, Clotilde Rey, David Chirouze, Catherine Bani-Sadr, Firouzé Cabié, André Huleux, Thomas Poizot-Martin, Isabelle Cotte, Laurent Isnard Bagnis, Corinne Flandre, Philippe PLoS One Research Article OBJECTIVE: We investigated whether patients receiving selected antiretroviral combinations had a higher risk of chronic kidney disease (CKD) using traditional regression modeling and a causal approach in a large prospective cohort. PATIENTS AND METHODS: For the purpose of this study, we selected 6301 patients who (i) started their first antiretroviral regimen after 1(st) January 2004, (ii) had at least one serum creatinine measurement within 6 months before ART initiation (study entry), and (iii) had at least two measurements after study entry. Baseline eGFR was defined from the last serum creatinine measurement before study entry. All eGFR values were calculated using the Modification of Diet and Renal Disease (MDRD) equation. Both traditional Cox proportional hazards model and Cox marginal structural models were applied. Distinct coding for antiretroviral therapy exposure were investigated as well as double robust estimators. RESULTS: Overall we showed that patients receiving tenofovir (TDF) with a ritonavir boosted protease inhibitor (rbPI) exhibited a higher risk of CKD compared with patients who received TDF with a non-nucleosidic reverse transcriptase inhibitor (NNRTI). Such an increased risk was observed considering both initial and current regimens. Our analysis revealed a clinician-driven switch away from TDF among persons experiencing a decline in renal function while receiving this drug. CONCLUSION: Our results show that combination of TDF and boosted protease inhibitor is associated with a higher CKD risk than TDF and a NNRTI. Public Library of Science 2017-12-07 /pmc/articles/PMC5720720/ /pubmed/29216208 http://dx.doi.org/10.1371/journal.pone.0187517 Text en © 2017 Cuzin et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Cuzin, Lise
Pugliese, Pascal
Allavena, Clotilde
Rey, David
Chirouze, Catherine
Bani-Sadr, Firouzé
Cabié, André
Huleux, Thomas
Poizot-Martin, Isabelle
Cotte, Laurent
Isnard Bagnis, Corinne
Flandre, Philippe
Antiretroviral therapy as a risk factor for chronic kidney disease: Results from traditional regression modeling and causal approach in a large observational study
title Antiretroviral therapy as a risk factor for chronic kidney disease: Results from traditional regression modeling and causal approach in a large observational study
title_full Antiretroviral therapy as a risk factor for chronic kidney disease: Results from traditional regression modeling and causal approach in a large observational study
title_fullStr Antiretroviral therapy as a risk factor for chronic kidney disease: Results from traditional regression modeling and causal approach in a large observational study
title_full_unstemmed Antiretroviral therapy as a risk factor for chronic kidney disease: Results from traditional regression modeling and causal approach in a large observational study
title_short Antiretroviral therapy as a risk factor for chronic kidney disease: Results from traditional regression modeling and causal approach in a large observational study
title_sort antiretroviral therapy as a risk factor for chronic kidney disease: results from traditional regression modeling and causal approach in a large observational study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5720720/
https://www.ncbi.nlm.nih.gov/pubmed/29216208
http://dx.doi.org/10.1371/journal.pone.0187517
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